General foreign aid and health aid are up but donors still not meeting targets

This blog was originally published by Global Health TV on Oct. 29, 2014.

After two years of declines, overseas development assistance (ODA) rebounded in 2013, but most donors have not met their commitments and are not sending a high enough proportion of their aid to the poorest countries, according to the ONE Campaign’s 2014 DATA Report.

Global health funding hit an all-time high of $31.3 billion in 2013, and funding for maternal, newborn and child health increased by nearly 18% between 2010 and 2011, reported the Institute for Health Metrics and Evaluation at the University of Washington in its annual report on global health financing.

And while aid donors are finally showing signs of improvement in meeting transparency commitments on that ODA, the majority – including the United States – is a long way from its commitment to adopt standards set by the Aid Transparency Index 2014.

These were some of the headlines coming out of two reports released this month, but very much overshadowed by the justified focus on Ebola, as well as an earlier report on global health financing released in April.

ONE’s DATA Report shows that although ODA increased in 2013 (the U.K. was responsible for most of that), donors’ total aid represented only 0.29% of their collective Gross National Income (GNI) – far below the UN target of 0.7%. In fact, only five of the 23 countries in the OECD Development Assistance Committee achieved 0.7% -- Norway, Sweden, Luxembourg, Demark and the U.K. (for the first time). The U.S. came in at 0.19%, lower than all but eight countries.

To be fair, the United States remains the largest bilateral aid donor in the world, having provided $31.4 billion in 2013. However, a decreasing percentage of its aid has gone to countries that need it to the most, reports ONE. “Last year – for the first time since 2005 – the U.S. is estimated to have cut its aid flows to sub-Saharan Africa by 1.4%,” said the DATA Report.

Moreover, donors as a whole spent just 0.09% of their collective GNI on aid to least developed countries in 2012, well below the UN target of 0.15-0.20%. LDCs remain highly dependent on aid.

The DATA Report also weighed in on the extent to which African nations are meeting their own health needs. In 2001, African leaders met in Abuja, Nigeria and pledged to allocate 15% of their national budgets to health. Between 2010 and 2012, just six of the 43 countries for which there was data available spent 15% of their budgets on health: Rwanda (23%), Malawi (18%), Swaziland (17%), Liberia (16.5%), Zambia (16%) and Togo (15%). Six additional countries – Lesotho, Namibia, Madagascar, Burundi, Burkina Faso and the Democratic Republic Congo – came close, with allocations greater than 13%. However, 18 countries did not reach even the 10% level.

While the Abuja target provides a useful metric, many global health experts consider per capita spending to be a better measure of a country’s capacity to meet its citizens’ health needs. That measure shows a very different picture, with eight countries providing health expenditures per capita in excess of $185  – Equatorial Guinea, Seychelles, South Africa, Namibia, Botswana, Mauritius, Gabon and Swaziland. Five of the six countries which met the Abuja target are nowhere near the top of the per capita list (only Swaziland is high on both lists). Twenty nations did not even spend $20 per capita for their citizens’ health.

Financing Global Health 2013: Transition in an Age of Austerity shows that although development assistance for health (DAH) reached an all-time high of $31.3 billion in 2013, the 4% growth from 2012 to 2013 “falls short of the rapid rates seen over 2001-2010, which topped 10% annually.

The report shows that non-communicable diseases (NCDs) and tobacco control received little funding, especially when one considers the substantial burden of disease associated with NCDs. For the first time, the report measured funding for tobacco control, which totaled $68 million in 2011. In comparison, funding for HIV/AIDS (the health issue receiving the most funding in 2011) was 113 times as large as the funding for tobacco control.

The Aid Transparency Initiative 2014 shows that overall, aid donors are showing signs of improve transparency but most are still a long way from meeting their commitments to publish using Aid Transparency Initiative standards.

The United Nations Development Program, the Department for International Development (of the U.K.), the Millennium Challenge Corporation (of the U.S.) and GAVI were found to be the four most transparent donors. The Global Fund to Fight AIDS, TB and Malaria was Number 10.

However, U.S. agencies were much lower on the list: The U.S. President’s Emergency Plan for AIDS Relief (Number 30) and the U.S. Agency for International Development (31) were rated on the low side of “fair” and the U.S. Department of State (32) was rated as “poor,” according to the Aid Transparency Index 2014. Some good news: PEPFAR showed the greatest improvement among the U.S. agencies and PEPFAR Coordinator Deborah Birx says that PEPFAR is committed to strengthening transparency further.

With one year before the expiration of the Millennium Development Goals, there has never been a better time for donors to truly meet their aid commitments and meet them in a transparent way.